Pod e-cigarettes less harmful than regular cigarettes, new study finds

November 18, 2020

PROVIDENCE, R.I. [Brown University] -- Cigarette smoking causes more than 480,000 deaths each year in the United States, according to federal government data -- and some smokers find it nearly impossible to quit. Many of these smokers use regular, or combustible, cigarettes.

Physicians and scientists have for many years explored the health benefits and drawbacks of nicotine-based alternatives to cigarettes, and new research offers significant evidence that "pod" e-cigarettes are less damaging to health than traditional cigarettes.

"Nicotine is one of the most addictive substances on earth, both in animal models as well as to humans," said Dr. Jasjit S. Ahluwalia, a professor of behavioral and social sciences and medicine at Brown University. "So how can we help these people who can't quit smoking combustible cigarettes? They need other options, and e-cigarettes may be one such option. Our research shows that in the short-term, e-cigarettes are considerably safer than combustible cigarettes."

Ahluwalia is senior author of a new JAMA Network Open study, published on Wednesday, Nov. 18, on the world's first randomized clinical trial of fourth-generation pod e-cigarettes.

The trial included 186 African American and Latinx smokers, as racial and ethnic minority groups tend to experience higher rates of tobacco-related morbidity and mortality even when they smoke at the same rates as other groups. Two-thirds of the participants were provided e-cigarettes for six weeks, while the remaining participants were instructed to continue smoking combustible cigarettes as usual.

By the end of the study, participants who switched to e-cigarettes exhibited significantly lower levels of the potent pulmonary carcinogen NNAL compared to those who continued to smoke combustible cigarettes exclusively. The e-cigarette users also had significantly reduced carbon monoxide (CO) levels and reported fewer respiratory symptoms. These benefits -- reduced NNAL, reduced CO and respiratory symptom improvements -- were especially pronounced among participants who switched completely to e-cigarettes.

The researchers also measured participants' levels of cotinine, a breakdown product of nicotine, and determined that there were no significant differences between groups, an indication that e-cigarettes provided adequate replacement of nicotine.

"Anyone under 21 should not take up cigarettes, e-cigarettes or any nicotine product -- hands down, the best thing to do is to never start -- but if people use tobacco products, they should quit," Ahluwalia cautioned. "But if they cannot quit smoking combustible cigarettes, they should consider using novel nicotine products to either quit smoking altogether or to reduce their harm by transitioning fully to these products."

Going forward, work needs to be done to better understand the non-cancer risks associated with e-cigarettes, such as respiratory and cardiovascular disease. The researchers also plan to carry out year-long studies to further explore the harm-reduction potential of e-cigarettes.

"Most smokers who switched exclusively from combustible cigarettes to e-cigarettes during the study maintained this behavior at six months, but we need longer-term follow-up," said Kim Pulvers, a professor of psychology at California State University San Marcos who was the principal investigator of the study. "We also need continued study of dual users to determine whether they maintain harm reduction over time."

Ahluwalia said that because many individuals who use both e-cigarettes and combustible cigarettes will switch back to exclusively combustible cigarettes over time, there is a critical need for interventions that support those who try to switch to e-cigarettes but fail. He also emphasized the importance of alternatives to quitting outright, given the challenge that quitting poses for so many cigarette smokers.

"It's possible that nicotine e-cigarettes and other harm-reduction products will be game-changers for our field," Ahluwalia added. "I hope this study stimulates more people to do this research and to have an open mind about this. I also hope it inspires them to let science inform policy rather than emotion."
-end-
In addition to Ahluwalia and Pulvers, additional contributors include Christopher H. Schmid and Kexin Qu from Brown; Nicole L. Nollen from the University of Kansas School of Medicine; Dr. Neal Benowitz from the University of California, San Francisco; and Myra Rice from California State University San Marcos.

Schmid served as a consultant for legal firms representing Eli Lilly, Boehringer-Ingelheim and Gilead outside the study. Benowitz received personal fees from Pfizer and Achieve Life Sciences and served as a consultant to pharmaceutical companies that market smoking cessation medications and as an expert witness in litigation against tobacco companies outside the study. Dr. Ahluwalia received personal fees from Lucy Goods outside the study. These points were fully disclosed in the study.

The study was funded by the National Institutes of Health (5SC3GM122628) and was also supported by the NIH-funded Center of Biomedical Research Excellence (P20GM130414) and the National Institute of General Medical Sciences of the NIH (U54GM115677).

Brown University

Related Nicotine Articles from Brightsurf:

Nicotine vapour more rewarding for adolescents than adults
University of Guelph researchers are the first to discover that adolescents react differently to e-cigarette vapour than adults.

Understanding the link between nicotine use and misuse of 'benzos'
Lately, misuse of prescription benzodiazepines (such as alprazolam or Xanax, and diazepam or Valium) has been linked to nicotine use.

Popular electronic cigarette may deliver nicotine more effectively than others
When it comes to nicotine delivery, not all electronic cigarettes are created equally, according to Penn State researchers.

Fetal nicotine exposure harms breathing in infants
Exposure to nicotine during development inhibits the function of neurons controlling the tongue, according to research in newborn rats recently published in eNeuro.

Diabetes drug relieves nicotine withdrawal
A drug commonly used to treat Type II diabetes abolishes the characteristic signs of nicotine withdrawal in rats and mice, according to new research published in JNeurosci.

The nicotine in e-cigarettes appears to impair mucus clearance
E-cigarette vaping with nicotine appears to hamper mucus clearance from the airways, according to new research published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

Truth telling about tobacco and nicotine
In 'Truth Telling about Tobacco and Nicotine,' PRC researchers explain that, although there is agreement among researchers about evidence that vaping can be less harmful than combustible cigarettes, the tobacco control community remains divided about how to communicate -- or even whether to communicate -- information about the relative risks of tobacco and nicotine products.

This is a neuron on nicotine
Newly developed sensors visually illustrate how nicotine affects cells from the inside out.

New data suggests nicotine while pregnant alters genes
A University of Houston biomedical research team is reporting that a possible cure for addiction may be found by following the pathways of significantly altered dopamine neurons in newborns who were chronically exposed to nicotine in utero.

Ex-smokers might be better off with high rather than low nicotine e-cigs
Vapers using low rather than high nicotine e-cigarettes may be using their devices more intensely, potentially increasing the risk of exposure to toxins in the vapour, according to new research funded by Cancer Research UK and published in Addiction today.

Read More: Nicotine News and Nicotine Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.